Obstetrics & Gynaecology

Managing Risks

  • September 1, 2019
  • 3 minutes read

Age, existing medical conditions and other factors can increase the chance of complications arising during pregnancy.

A pregnancy is considered high-risk when the mother has an increased chance of pregnancy complications or her fetus has a higher chance of experiencing health problems. While the risks are there, it doesn’t mean that mother and child will definitely be adversely affected.

Risk factors

Age: One key factor is age. First-time mothers who are over 35 are more likely to encounter problems with conception and pregnancy complications such as developing medical disorders in pregnancy, requiring assisted deliveries. In women who are over 40, the risks of chromosomal abnormalities increase significantly and, with it, the risk of miscarriage and birth defects.

Women under 17 are at risk of developing high blood pressure and smaller babies. As teen pregnancies are often not as well looked after as those of more mature women, poor nutrition is a common issue.

Lifestyle: Obesity increases the risk for pre-eclampsia (a condition in pregnancy characterised by high blood pressure), gestational diabetes (diabetes that develops during pregnancy), stillbirth and neural tube defects (birth defects of the brain, spine or spinal cord). Some research indicates that obesity can impact the future health of a child and raise his or her risk of developing heart problems.

Alcohol and smoking are also detrimental to fetal health. They can cause reduction in the fetal growth potential and have a negative impact on intellectual development.

Medical disorders: Diabetes may not be evident and should be screened for, especially when there is family history. A diabetic mother with good glucose control has almost the same risk as any other mother of the same age, but one with poor control increases the risk of fetal abnormalities and pregnancy complications.

An overactive or underactive thyroid should be optimally managed to improve the health and fertility of the potential mother and reduce risk to her fetus. The mother-to-be should also be screened for other conditions, including autoimmune diseases (eg lupus) and clotting disorders when there is a suspicion of abnormalities.

Even healthy women can experience high-risk issues during pregnancy. These include pre-eclampsia and gestational diabetes. This is why it is important for parents-to-be to consult a doctor for preconception evaluation, as this helps the couple and their doctor optimise the health of the mother (and father, preferably) prior to the pregnancy.

Gynaecological problems: Conditions that affect the reproductive organs can have an impact on the safety of the unborn child and the birth. For instance, uterine fibroids, endometriosis and ovarian cysts may affect conception and increase the risk of miscarriages or preterm labour. In rare cases, fibroids can partially obstruct the birth canal. Conditions that affect the reproductive organs can have an impact on the safety of the unborn child and the birth. For instance, uterine fibroids, endometriosis and ovarian cysts may affect conception and increase the risk of miscarriages or preterm labour. In rare cases, fibroids can partially obstruct the birth canal.

If you suffer from any of these conditions, it is important to speak to your doctor to determine the best way to manage these issues before, during and after pregnancy. Treatment may take the form of medication or surgery, and management is based on individual circumstances.

Cervical incompetence: Women suffering from cervical incompetence due to a prior cervical surgery (eg surgery for an abnormal Pap smear) may suffer from a weakened and shortened cervix, causing it to open prematurely, leading to a miscarriage or preterm birth.

In such cases, a procedure called a cervical cerclage can be done to place a small, woven synthetic band to support the cervix and prevent it from opening. Awareness that such an issue can occur can help the gynaecologist better plan the care of the pregnancy.

Multiple pregnancies: For women who are expecting more than one infant (twins, triplets, quadruplets, etc), or who have had a previous preterm birth, there is an increased risk of premature labour, gestational diabetes and pregnancy-induced high blood pressure. In these cases, the doctor may recommend closer monitoring to anticipate and reduce the risk of miscarriage or premature birth.

Assisted reproduction: High-risk pregnancies are becoming more common with the rise of fertility treatments — not because of the procedure, but because women who undergo these treatments are typically older and have underlying fertility conditions such as cycle irregularities, uterine anomalies and obesity.

Prevention and management

Pre-conception planning and regular visits to the doctor can go a long way to alleviate some of the concerns surrounding these potential high-risk pregnancies, particularly when there is a pre-existing or family history of illness.

A thorough review can help you and your doctor to take steps to assess and manage risks. Some recommendations may include:

  • Taking a combination of prenatal multivitamins, minerals and folic acid daily, starting from three months prior to conception
  • Getting immunised against preventable infectious diseases (eg rubella and hepatitis B)
  • Maintaining a healthy lifestyle with a balanced diet and regular exercise
  • Avoiding smoking and alcohol
  • Regular screenings and follow-ups once pregnancy is achieved

With early identification and treatment of medical issues where needed, the pregnancy will have a good chance of being a smooth cruise towards delivery of a healthy baby.

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